Central Nervous System

The stress associated with arrest and detention in custody may also have significant effects on the cerebrovascular system and may, in susceptible individuals, precipitate intracerebral hemorrhage by the rupture of congenital or acquired aneurysms or vascular malformations. Ruptured berry aneurysms will result in the development of acute subarachnoid hemorrhages. It is less likely that these intracranial hemorrhages will result in sudden death, but they may result in sudden unconsciousness, which ultimately leads to death. Clearly, the distinction between hemorrhage resulting from a natural disease process and death resulting from trauma will need to be established and a specialist neuropathological examination will be required should death occur.

As with the heart, the possibility that an infectious process within the central nervous system (CNS) is the cause of sudden collapse and death must be considered. However, it is unlikely that meningitis or encephalitis will present without any prodromal symptoms. Epilepsy is unlikely to develop de novo after arrest and detention, but epilepsy can and does lead to sudden collapse and death, and a pre-existing history of epilepsy is clearly important. Any individual known to suffer from epilepsy should be monitored with the utmost care and his or her prescribed medication continued.

Other forms of intracranial pathology that may lead to sudden death include tumors, both benign and malignant, and such rarities as the development of colloid cysts of the ventricular system.

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